Module 6 Flashcards
Acute pancreatitis is particularly painful.
What is happening to induce such pain?
What interventions would you be implementing to diminish symptoms?
Which medications would be used and how would they be administered?
What advice can you give to the patients being discharged from hospital?
What is happening to induce such pain?
Increased pressure within the ductal system and/or the parenchyma has been suggested to be one of the causes of pain.
Inflammation of pancreatic nerves.
Elevated levels of neuropeptides and neurotransmitters in afferent pancreatic nerves.
Obstruction of common bile duct.
Duodenal stenosis.
What interventions would you be implementing to diminish symptoms?
Prophylactic antibiotics Analgesia, antiemetics NBM NGT Regular LFTs to monitor for risk of biliary obstruction Controlled fluid replacement 5-10ml/24 Early nasojejunal nutrition
Which medications would be used and how would they be administered?
Analgesics: opioids - morphine, fentanyl etc - IV SC IM
Antiemetics: metroclopramide, ondansetron - IV IM
Octerotide - SC for pseudocysts
Antibiotics: piperacillin + tazobactam, ceftriaxone, metronidazole - IV
Nitrates: sublingual GTN
Insulin - SC, IV
Calcium glutinate (for hypocalcaemia)
What advice can you give to the patients being discharged from hospital?
Avoid alcohol. Discuss with doctor rationale for possible Cholecystectomy Avoid paracetamol if hepatic impairment High carb, low fat diet Eat small, regular meals Monitor blood sugar levels
Describe the nursing care of a person with a bowel obstruction.
NGT - NBM, monitor tube drainage, colour & consistency.
Prep for surgery if required.
Radiography/ultrasound.
Pain management.
Maintain fluids with IV hydration.
IV antibiotics if ischaemic bowel suspected.
Frequent nursing observations.
Monitor urine output.
Education re constipation/adhesions/meds PRN.
An ileum may occur postoperatively. What is an ileus and how would you know if a patient has one?
Temporary cessation of peristalsis.
Manifested by N&V, abdominal discomfort, diminished or absent bowel sounds.
May see accumulation of gas on x-ray/ultrasound, CT scan may be used to differentiate between ileus and obstruction.
Following bowel surgery large amounts of fluid sequester in the bowel for a period of time. What are the nursing responsibilities in this situation and would would you be monitoring?
NGT - NBM, monitor tube drainage, colour & consistency.
Monitor peristalsis - check bowel sounds are regular.
Maintain fluid balance (current guidelines suggest restrictive fluid balance reduces mortality after bowel resection).
Check abdominal girth regularly and exclude distention.
Encourage mobilisation.
Diarrhoea and constipation can occur for a number of reasons. Review these and then discuss the medications which might be helpful. What information would you provide to the client regarding other actions that may be useful?
Diarrhoea:
Opioids are most effective non-specific antidiarrhoeal agents - codeine, diphenolxylate, loperamide.
Bulk-forming laxatives eg. psyllium due to fluid absorption properties.
Oral rehydration salts - gastrolyte powders.
Infectious diarrhoea may require an anti-infective.
Constipation:
Bulk-forming laxatives - best for simple constipation.
Osmotic laxatives - glycerol, lactulose, macrogol.
Stimulant laxatives - act by direct stimulation of nerve endings in colonic mucosa to increase intestinal motility. May also cause accumulation of water and electrolytes in the colonic lumen. Includes bisacodyl, senna and picosulfate.
Patient education - useful actions:
Adequate dietary fibre intake (18-30g daily). Increase gradually to avoid bloating and flatulence.
Adequate fluid intake.
Increase activity/exercise.
Immediately responding to urge to defecate and using toilet after meals as gastrocolic reflex is maximal.
“Politely” and such like preparations are given preoperatively to patients about to undergo procedures where good visualisation of the bowel is required or where bowel emptying and cleanliness is important. What is this substance and how is it administered? What advice would you give to the client at home and what nursing actions would be appropriate for an inpatient?
Polyethylene glycol - osmotic laxative, draws water into the bowel.
“Macrogols or polyethylene glycols (PEGs) are large polymers with osmotic activity. Most products combine electrolytes with macrogols; these solutions are iso-osmotic with respect to normal intestinal contents, which minimises electrolyte and water loss. Some products also contain sodium sulphate, a saline laxative that stimulates peristalsis.” (AMH, 2015)
Advice:
Diarrhoea usually starts within 1 hour. Drink clear fluids in addition to the product. Including broths and clear fruit juices to maintain electrolyte balance and energy.
Continue with the treatment until the stool appears clear with no debris. It can be green or yellow in colour, but you need to keep drinking the product as long as there is solid matter.
